论文部分内容阅读
目的评价腹腔镜和同期开腹直肠癌根治术在肿瘤学结果方面的差异。方法分析南方医院2003年1月至2008年12月期间520例行直肠癌根治术的TNMⅠ～Ⅲ期病例的临床随访资料,其中腹腔镜组186例,开腹组334例,对2组术后复发、生存等肿瘤学结果进行比较。结果腹腔镜组和开腹组基本临床病理特征及辅助治疗情况具有均衡可比性。2组平均随访30.3个月。腹腔镜组与开腹组比较,3年累积生存率为83%比80%,远处转移率为12.5%比15.6%,戳孔/切口癌转移率为0.6%比0,差异均无统计学意义(P>0.05);局部复发率为4.8%比10.7%,3年累积无病生存率为81%比68%,差异均具有统计学意义(P<0.05)。生存分析显示,累积生存率2组差异无统计学意义(P=0.142),而累积无病生存率腹腔镜组则显著高于开腹组(P=0.010)。Ⅰ或Ⅱ期病例中2组局部复发率、远处转移率、累积生存率及累积无病生存率的差异均无统计学意义(P>0.05);Ⅲ期病例远处转移率、累积生存率差异亦无统计学意义(P>0.05),但Ⅲ期病例腹腔镜组局部复发率显著低于开腹组(6.8%比17.7%,P=0.047),累积无病生存率则显著高于开腹组(P=0.045)。结论腹腔镜直肠癌根治术可以达到甚至优于同期开腹根治术的肿瘤学结果 ,提示针对直肠癌的腹腔镜外科前瞻性随机对照研究的可行性和必要性。
Objective To evaluate the difference in the results of laparoscopy and concurrent radical resection of rectal cancer in oncology. Methods The clinical follow-up data of 520 cases of TNMⅠ-Ⅲ cases undergoing radical resection of rectal cancer from January 2003 to December 2008 in Southern Hospital were analyzed. There were 186 cases in laparoscopic group and 334 cases in open group. Recurrence, survival and other oncology results were compared. Results The basic clinical and pathological characteristics of laparoscopic group and open group were balanced and comparable. Two groups were followed up for an average of 30.3 months. Compared with the laparotomy group, the 3-year cumulative survival rate of laparoscopic group was 83% and 80%, distant metastasis rate was 12.5% and 15.6% respectively, and the rate of poke hole / incision cancer metastasis was 0.6% and 0, respectively, with no statistical difference (P> 0.05). The local recurrence rate was 4.8% vs 10. 7%, and the 3-year cumulative disease-free survival rate was 81% vs 68%. The differences were statistically significant (P <0.05). Survival analysis showed that the cumulative survival rate was no significant difference between the two groups (P = 0.142), while the cumulative disease-free survival rate in laparoscopic group was significantly higher than that in open group (P = 0.010). There was no significant difference in the recurrence rate, distant metastasis rate, cumulative survival rate and cumulative disease-free survival rate between the two groups in stage Ⅰ or Ⅱ (P> 0.05). The distant metastasis rate and cumulative survival rate in stage Ⅲ The difference was not statistically significant (P> 0.05). However, the recurrence rate of stage Ⅲ laparoscopic group was significantly lower than that of laparotomy group (6.8% vs 17.7%, P = 0.047), and the cumulative disease-free survival rate was significantly higher than that of open group Abdominal group (P = 0.045). Conclusions Laparoscopic radical resection of rectal cancer can achieve or even surpass the results of concurrent radical resection of oncology, suggesting the feasibility and necessity of prospective randomized controlled laparoscopic surgery for rectal cancer.